Environmental Factors Contributing to Upper Eyelid Ptosis:
A Study of Identical Twins
Matthew Brown, MD, Nick Satariano, BS, Samantha Zwiebel, MA, Bahman Guyuron, MD.
Case Western Reserve, Cleveland, OH, USA.
Involutional ptosis of the upper eyelid is most often attributed to dehiscence or laxity of the levator aponeurosis. Current literature provides little information about the impact of environmental exposures on the severity of acquired blepharoptosis. This study was designed to assess environmental factors that may contribute to ptosis in an identical twin population.
286 sets of twins were reviewed from a prospectively collected database from 2008 to 2010. 96 identical twin sets, 192 individuals, were visually identified as having differential amounts of ptosis between twins. Digital photographs were analyzed and a calculated ptosis measurement was performed in each eye of every subject. Statistics were performed using a generalized linear mixed model correlating ptosis measurements with environmental risk factors obtained from the subject survey database.
96 twins sets with 77% female and 23% male were analyzed. The mean amount of ptosis measured was 1.1mm. The mean differential ptosis between the more and less ptotic twin was 0.5mm. Nine different environmental risk factors were assessed for correlation with ptosis. Contact lens use, both hard and soft, was significantly associated with ptosis. Mean ptosis of all non-contact lens users was 1.0mm, soft contact lens users was 1.41mm, and hard contact lens users was 1.84mm.
Acquired ptosis is not linked to BMI, smoking, sun exposure, alcohol use, work stress, or sleep. There is, however, a significant impact with contact lens use, both hard and soft lenses. These are shown to be independent of genetic predisposition. Hard contact lens use is associated with more ptosis than soft contact lens use. These deformities are amendable to surgical correction with the modified putterman technique.
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